On Anticipating Consequences

Following a community-level or society-level catastrophe, an almost-formulaic utterance of officials, speaking to the public through media, begins something like, "Due to unforeseen events,…" or "Because of unintended consequences,…" For example, at the start of World War I, in 1915, and following the loss of RMS Titanic and 2224 people on 15 April 1912, the U.S. Congress passed the Seamen's Act. Among other regulations, the act required that vessels carry enough lifeboats for all on board. The SS Eastland was therefore retrofitted with lifeboats for 2,000. [Eastland Memorial Society 2007]

In the case of the Eastland, however, this decision had unintended consequences. She had a history of instability. Beyond the retrofitting of lifeboats, she had undergone recent changes that made her even more top-heavy. At 6:30 AM on July 24, at the wharf in Chicago, minutes after the start of loading the first of thousands of passengers, the ship began to list to starboard. The listing increased until the ship finally settled on her port side at 7:32 AM. Trapped or crushed by heavy furniture and equipment, 844 died, including 841 passengers.

In retrospect, The hallmark of incidents involving unintended —
and sometimes unanticipated — consequences is
the urge to ask, "What were they thinking?"what happened to the Eastland makes so much sense that one wonders, "What were they thinking?" And that is the hallmark of incidents involving unintended, and sometimes unanticipated consequences. What happened to the Eastland was unintended, but certainly not unanticipated. During testimony before Congress regarding the Seamen's Act, A.A. Schantz, general manager of the Detroit and Cleveland Navigation Company argued against increasing lifeboat requirements for Great Lakes vessels, of which the Eastland was one, because the additional weight would cause many vessels to become top heavy and prone to capsizing.

Natural questions arise:

• How can we improve our capacity to anticipate unwelcome consequences?
• How can we avoid situations likely to be fraught with unwelcome consequences?
• When someone does notice an elevated risk of unwelcome consequences, how can we limit the chances of inappropriately rejecting the warning?

How we can improve our ability to anticipate

One approach for improving anticipation effectiveness involves studying problem solving techniques, and applying them to the matter at hand to model results of making a change. But we don't always have the time or resources these approaches require. A low-cost, rapid alternative exploits a technique known as morphological analysis. [Ritchey 1998]

One of the advantages of morphological analysis is its applicability to problems that are mathematically intractable. Another advantage is that its discipline compels us to consider features of the problem space that we might otherwise overlook or avoid. Let's see how this works in an example studying the effects of a set of changes on the attributes of a system.

Direct effects

We begin with direct effects. When we make a change to a system, some of the system's attributes might change as a result. For example, after the 1903 season, the owners of the SS Eastland added an air conditioning system for passenger comfort. This added weight to the vessel, increasing its draft. In this example, increased draft was a direct effect of adding air conditioning. Increased draft eventually became a problem for navigation because the waters of the Black River in Michigan weren't deep enough for the Eastland, and that became a problem to be solved. Direct effects aren't always problematic, but this one was.

To uncover all direct effects can be tricky, and that's why morphological analysis can be helpful. It works like this. We begin examination of the system we're changing by listing the attributes we care most about. For example, our list might consist of the set {A1, A2, A3, A4}. A1 might be, for example, the draft of the Eastland.

Next, we make a list of the changes we're planning to make. In our example, let's suppose the changes are {C1, C2, C3}. C1 might be, in our example, air conditioning. The number of attributes is immaterial, as is the number of changes. Typically there will be many of both, but I'm keeping the numbers small for this illustration.

What we want to know in this example is how each change affects each attribute. To guide our consideration, we form the so-called outer product of these two lists:

C1-A1, C1-A2, C1-A3, C1-A4, C2-A1, C2-A2, C2-A3, C2-A4, C3-A1, C3-A2, C3-A3, C3-A4

This list provides a framework for close examination of the direct effects of each change on each system attribute. C1-A1 might be the effect of air conditioning on vessel draft. We might not be able to project each direct effect in detail, but using the framework gives us confidence that we won't overlook any direct effects.

Indirect effects

Suppose we make a change that produces a change in a system attribute as a direct effect. That change in one system attribute can produce secondary changes in other system attributes. We can regard these secondary changes as indirect effects of the first change. So, for example, C1 might change A1, and that can cause a change in A2. The change in A2 is an indirect effect of C1.

In our example of the SS Eastland, the increased draft (A1) resulting from the added weight of the air conditioning (C1) decreased the vessel's speed (A2).

Although morphological analysis provides no direct assistance with tracking indirect effects on system attributes, in most cases, we will need to attend to indirect effects.

Compensation chains

The purpose of some system changes is compensation for the direct or indirect effects of other system changes. In our abstract example, suppose C3 is such a compensating change with respect to the attribute A4. Then the change in A4, namely C1-A4 + C2-A4 + C3-A4, consists of two direct effects (C1-A4 + C2-A4) and one compensation effect (C3-A4).

We need not treat compensating changes differently from other changes, except that they can often occur at later dates, after we realize the need for them as a result of other changes.

Most important, compensation changes can occur in chains. That is, we decide to deploy C5 because of the effects of C4, which we decided to deploy because of the effects of C3. Compensation chains can indicate a loss of coherence in system architecture, as we patch and patch again, trying to keep the system running. Even one such chain can indicate the need for a thorough system review.

In the case of the SS Eastland, the 1903 season revealed that its speed performance was well below the contract requirement. After that season, the owners decided to deploy an Ellis and Eaves induced draft system to increase power. The combined weight of this system and the air conditioning equipment is what created the vessel draft issue, which was addressed by shifting equipment around within the vessel. And that reconfiguration contributed to her stability problems. [Eastland Memorial Society 2007] Those stability problems would eventually lead to the loss of the vessel and 844 lives.

Last words

Tracing the changes made to a complex system over the life of that system can reveal details about how the system responds to change. That information can be sufficient to prevent formation of compensation chains or what is worse — compensation loops. Even though we might lack the ability to project all effects of changes on the basis of first principles, knowledge of the system's response to previous changes might provide all that is necessary to project its response to future changes.  Top    Next Issue

Is your organization embroiled in Change? Are you managing a change effort that faces rampant cynicism, passive non-cooperation, or maybe even outright revolt? Read 101 Tips for Managing Change to learn how to survive, how to plan and how to execute change efforts to inspire real, passionate support. Order Now!

Footnotes

Your comments are welcome

Would you like to see your comments posted here? rbrenyrWpTxHuyCrjZbUpner@ChacnoFNuSyWlVzCaGfooCanyon.comSend me your comments by email, or by Web form.

About Point Lookout

Thank you for reading this article. I hope you enjoyed it and found it useful, and that you'll consider recommending it to a friend.

This article in its entirety was written by a human being. No machine intelligence was involved in any way.

Point Lookout is a free weekly email newsletter. Browse the archive of past issues. Subscribe for free.

Support Point Lookout by joining the Friends of Point Lookout, as an individual or as an organization.

Do you face a complex interpersonal situation? Send it in, anonymously if you like, and I'll give you my two cents.

Related articles

More articles on Organizational Change:

Conventional Foolishness

Every specialization has a set of beliefs, often called "conventional wisdom." When these beliefs are so obvious that they're unquestioned and even unnoticed, there's an opportunity to leap ahead of the pack — by questioning the conventional wisdom.

When Fear Takes Hold

Leading an organization through a rough patch, we sometimes devise solutions that are elegant, but counterintuitive or difficult to explain. Even when they would almost certainly work, a simpler fix might be more effective.

How to Find Lessons to Learn

When we conduct Lessons Learned sessions, how can we ensure that we find all the important lessons to be learned? Here's one method.

Way Over Their Heads

For organizations in crisis, some but not all their people understand the situation. Toxic conflict can erupt between those who grasp the problem's severity and those who don't. Trying to resolve the conflict by educating one's opponents rarely works. There are alternatives.

Contrary Indicators of Psychological Safety: II

When we begin using new tools or processes, we make mistakes. Practice is the cure, but practice can be scary if the grace period for early mistakes is too short. For teams adopting new methods, psychological safety is a fundamental component of success.

See also Organizational Change and Organizational Change for more related articles.

Forthcoming issues of Point Lookout

Coming September 4: Beating the Layoffs: I

If you work in an organization likely to conduct layoffs soon, keep in mind that exiting voluntarily before the layoffs can carry significant advantages. Here are some that relate to self-esteem, financial anxiety, and future employment. Available here and by RSS on September 4.

And on September 11: Beating the Layoffs: II

If you work in an organization likely to conduct layoffs soon, keep in mind that exiting voluntarily can carry advantages. Here are some advantages that relate to collegial relationships, future interviews, health, and severance packages. Available here and by RSS on September 11.

Coaching services

I offer email and telephone coaching at both corporate and individual rates. Contact Rick for details at rbrenyrWpTxHuyCrjZbUpner@ChacnoFNuSyWlVzCaGfooCanyon.com or (650) 787-6475, or toll-free in the continental US at (866) 378-5470.

Get the ebook!

Past issues of Point Lookout are available in six ebooks:

• Get 2001-2 in Geese Don't Land on Twigs (PDF, )
• Get 2003-4 in Why Dogs Wag (PDF, )
• Get 2005-6 in Loopy Things We Do (PDF, )
• Get 2007-8 in Things We Believe That Maybe Aren't So True (PDF, )
• Get 2009-10 in The Questions Not Asked (PDF, )
• Get all of the first twelve years (2001-2012) in The Collected Issues of Point Lookout (PDF, )

Are you a writer, editor or publisher on deadline? Are you looking for an article that will get people talking and get compliments flying your way? You can have 500-1000 words in your inbox in one hour. License any article from this Web site. More info